Santoro-Lopes Guilherme, de Lemos Alberto dos Santos, Halpern Márcia, Gonçalves Renato Torres, Santos Marcos André Alves Rosa, Valiante Paulo Marcos Nunes
Infectious Diseases Clinic, Hospital Universitario Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Exp Clin Transplant. 2011 Oct;9(5):340-3.
Cytomegalovirus is an important cause of colonic disease in solid organ transplant recipients. Although several reports have shown that simultaneous infection with other pathogens may aggravate the course of cytomegalovirus colitis, to our knowledge, no case of colitis caused by simultaneous cytomegalovirus and Mycobacterium tuberculosis has been previously reported. We describe a case of hemorrhagic colitis associated with simultaneous cytomegalovirus/ Mycobacterium tuberculosis infection in a 26-year-old woman, 38 months after a kidney transplant. Initial results of histopathologic analyses of gastrointestinal biopsies showed that tuberculosis was the only cause of colitis, as no morphologic alteration suggestive of cytomegalovirus infection was observed on hematoxylin-eosin staining. However, further analysis with immunoperoxidase staining confirmed the clinical suspicion of cytomegalovirus infection. This report shows that cytomegalovirus/tuberculosis coinfection may be a cause of late-onset colitis among solid organ transplant recipients. It also illustrates that coinfection with other pathogens may pose an additional challenge for diagnosing gastrointestinal cytomegalovirus disease.
巨细胞病毒是实体器官移植受者结肠疾病的重要病因。尽管有几份报告显示，同时感染其他病原体可能会加重巨细胞病毒结肠炎的病程，但据我们所知，此前尚无同时感染巨细胞病毒和结核分枝杆菌导致结肠炎的病例报告。我们描述了一名26岁女性在肾移植38个月后发生的与巨细胞病毒/结核分枝杆菌同时感染相关的出血性结肠炎病例。胃肠道活检的组织病理学分析初步结果显示，结核病是结肠炎的唯一病因，因为苏木精-伊红染色未观察到提示巨细胞病毒感染的形态学改变。然而，免疫过氧化物酶染色的进一步分析证实了临床对巨细胞病毒感染的怀疑。本报告表明，巨细胞病毒/结核分枝杆菌合并感染可能是实体器官移植受者迟发性结肠炎的病因之一。它还表明，与其他病原体的合并感染可能给胃肠道巨细胞病毒疾病的诊断带来额外挑战。
